Management Of Subclinical Hypothyroidism Research Articles

Comparative Effectiveness of Varunadi Ghan Vati and Kanchnar Guggulu in Management of Subclinical Hypothyroidism- Study Protocol for a Randomized Controlled Trial

Abstract: Background: Hypothyroidism is an emerging disease nowadays. India has a high prevalence of Hypothyroidism, which is about 10%. Hormone replacement therapy is advised in the treatment of hypothyroidism. However, in subclinical hypothyroidism, no treatment is advised. Ayurveda describes a number of treatment modalities for the treatment of disease on the basis of their dosha-dushya. The aim of this study is to evaluate the effectiveness of Varunadi Ghan Vati in comparison with Kanchnar Guggulu in the management of subclinical hypothyroidism. Methods and Design: This study will be a prospective, single-centered, randomized controlled trial. A total of 60 patients of age between 19 and 60 years, diagnosed with subclinical hypothyroidism, and presented with cardinal features of the disease will be randomized into two groups. In Group A, patients will be given Varunadi Ghan Vati and in Group B patients will be given Kanchnar Guggulu. Pathya-Apathya regarding the disease will be guided to both groups. Both groups will receive treatment for 45 days. Outcomes will be evaluated on the 15th, 30th and 45th days (during treatment) and 75 th day(post-treatment). The primary outcome will be evaluated on the basis of cardinal symptoms of subclinical hypothyroidism. Improvement in laboratory investigations will be evaluated for secondary outcomes. Conclusion: This trial is the first to compare the effectiveness of Varunadi Ghan Vati with Kanchnar Guggulu in the management of subclinical hypothyroidism. Varunadi Ghan Vati is expected to improve the symptoms of subclinical hypothyroidism, thus proving to be effective in the management of patients with subclinical hypothyroidism. Trial registration: CTRI/2023/07/055295

Estimation of left ventricular functions in patients with subclinical hypothyroidism: a meta-analysis.

To evaluate left ventricular (LV) function in patients with subclinical hypothyroidism (ScH) compared to healthy individuals and to provide clinical hints for practitioners. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched in this meta-analysis. Studies evaluating LV function in ScH patients were included. Standardized mean difference (SMD) and the 95% confidence intervals (CIs) were calculated as effect size. Heterogeneity and risks of bias of included studies were assessed. A total of 9 studies were identified as eligible. The SMD for fractional shortening (FS, %) was -0.21 (95% CI: -0.60, 0.17; z = -1.08, p = 0.2788). The pooled SMD for systemic vascular resistance (SVR, dynes/sec·cm-5) was -0.41 (95% CI: -1.31, 0.49; z = -0.89, p = 0.3744). The pooled SMD for early diastolic mitral flow velocity/late diastolic mitral flow velocity (E/A) ratio was -0.74 (95% CI: -1.09, -0.39; z = -4.13, p < 0.001). The pooled SMD for ejection fraction (EF, %) was -0.35 (95% CI: -0.59, -0.12; z = -2.95, p = 0.0032). ScH patients had significantly worse LV function parameters than healthy controls. These changes in LV function may be involved in the management of ScH.

Frequency of Subclinical Hypothyroidism in Patients with First-Trimester Pregnancy Loss

Objectives: To determine the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology &amp; Obstetrics Department, Combined Military Hospital, Rawalpindi Pakistan,from Jun 2018 to Dec 2018. Methodology: The study included 130 women aged 18-40 years who had first-trimester pregnancy loss. Patients withchronic renal failure, known thyroid disorders and taking medication that can affect thyroid functions were excluded. Venous blood samples were taken to analyse thyroid function tests, and subclinical Hypothyroidism was noted. Results: The mean age of the women was 28.68±4.80 years. Most patients 77(59.23%), were between 18 and 30 years old. The mean BMI was 29.42±2.50 kg/m2. 16(12.31%) women with first-trimester miscarriage had subclinical Hypothyroidism. Conclusion: This study concluded that the frequency of subclinical Hypothyroidism in women with first-trimester pregnancy loss was significant. Proper management protocol for early recognition and management of subclinical Hypothyroidism in women can improve pregnancy outcomes.

Management of Subclinical Hypothyroidism: A Focus on Proven Health Effects in the 2023 Korean Thyroid Association Guidelines.

Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age <70 years) or elderly (age ≥70 years), depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, including a thyroid peroxidase antibody test, preferably 2 to 3 months after the initial assessment. While LT4 treatment is not generally recommended for mild SCH in adults, it is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and it may be considered for those with concurrent dyslipidemia. Conversely, LT4 treatment is generally not recommended for elderly patients, regardless of SCH severity. For those SCH patients who are prescribed LT4 treatment, the dosage should be personalized, and serum TSH levels should be regularly monitored to maintain the optimal LT4 regimen.

Subclinical Hypothyroidism Diagnosis and Management in Primary Care settings

Subclinical hypothyroidism is a prevalent thyroid disorder characterized by elevated thyroid-stimulating hormone (TSH) levels and normal free thyroxine (T4) levels. Its diagnosis and management in primary care settings present ongoing challenges and uncertainties. This systematic review aims to evaluate the current evidence regarding the diagnosis and management of subclinical hypothyroidism in primary care, with a focus on diagnostic criteria, clinical outcomes, and treatment approaches. A comprehensive search of electronic databases (PubMed, Embase, Cochrane Library) was conducted to identify relevant studies published in English within the last 10 years. Randomized controlled trials, cohort studies, and systematic reviews were included. Study selection, data extraction, and quality assessment were performed by two independent reviewers. The findings were synthesized descriptively, and meta-analysis was conducted when appropriate. A total of 25 studies met the inclusion criteria and were included in this review. Diagnostic criteria for subclinical hypothyroidism varied across the studies, with differing TSH thresholds used to define the condition. The clinical outcomes associated with subclinical hypothyroidism were heterogeneous, including cardiovascular risks, metabolic disorders, and quality of life. The management of subclinical hypothyroidism in primary care was diverse, ranging from watchful waiting to levothyroxine therapy. The benefits of levothyroxine treatment were inconclusive, with some studies reporting improvement in symptoms and lipid profiles, while others found no significant differences compared to placebo or observation. The diagnosis and management of subclinical hypothyroidism in primary care remain controversial. The variability in diagnostic criteria and inconsistent evidence on clinical outcomes and treatment efficacy complicate decision-making. Future research should focus on establishing standardized diagnostic thresholds, evaluating ....

Homoeopathic Treatment of Young Females with Subclinical Hypothyroidism: A Prospective Observational Study

Abstract Introduction Subclinical hypothyroidism (SCH) is defined as elevated levels of serum thyroid-stimulating hormone (TSH) (TSH: 5–20 μIU/mL; normal range: 0.15–3.5 μIU/mL) with normal serum levels of free thyroid hormones mainly free T4 (0.89–1.76 ng/dL). SCH does not affect the development process very much and hence there are no universally accepted recommendations for its treatment but it is important to have optimal thyroid function for normal growth and development in children; it may progress to overt hypothyroidism and other health issues. So, its diagnosis in early stage of life and hence its treatment will definitely benefit the growing children. Objective The objective of this study is to review the role of homoeopathy in SCH in younger aged females. Method Total 212 cases were screened, 54 diagnosed cases of SCH were enrolled on the basis of inclusion criteria and 4 cases dropped out from the study. Total 50 cases were given individualised homoeopathic medicines based on repertorisation of totality of symptoms and in consultation with Materia Medica. Result Results showed significant difference after comparing pre- and post-treatment values using paired t-test; the difference in mean values of Serum TSH values was found to be statistically significant (p-value &lt; 0.00001). At baseline, the mean TSH level was 7.158 μIU/mL which decreased to 4.368 μIU/mL (p &lt; 0.00001). Conclusion This study indicates the positive role of homoeopathic therapy in the management of SCH. Such study with bigger sample size through randomised controlled trial is needed for further validation.

Reference intervals for thyroid hormones for the elderly population and their influence on the diagnosis of subclinical hypothyroidism.

This study aims to establish reference intervals (RIs) for thyroid hormones in the elderly population and analyze their influence on the prevalence of subclinical hypothyroidism. Thyroid hormone records of subjects who underwent routine health checkup at our hospital between 2018 and 2020 were analyzed. Thyroid stimulating hormone (TSH), total triiodothyronine, total thyroxine, free triiodothyronine (FT3), and free thyroxine (FT4) levels were compared between young and elderly subjects. Thresholds of these thyroid hormones were established for elderly subjects. A total of 22,207 subjects were included. Of them, 2,254 (10.15%) were aged ≥ 65 years. Elderly subjects had higher TSH, and lower FT3 and FT4 levels when compared with young subjects. In the elderly group, the RIs for TSH, FT3 and FT4 were 0.55-5.14 mIU/L, 3.68-5.47 pmol/L, and 12.00-19.87 pmol/L, respectively. The age and sex specific RIs for TSH were 0.56-5.07 mIU/L for men and 0.51-5.25 mIU/L for women. With whole-group RIs and age and sex-specific RIs for elderly people, the prevalence of subclinical hypothyroidism was 9.83% and 6.29% (p < 0.001), respectively. Elderly individuals had higher TSH levels than young individuals. Our study indicated that establishing specific RIs for elderly individuals is needed. This has implications for the diagnosis and management of subclinical hypothyroidism in the elderly population.

AN UPDATE ON SUBCLINICAL HYPOTHYROIDISM, COMPLICATIONS, AND ITS MANAGEMENT BY AYURVEDIC MEDICINES: A REVIEW

Subclinical hypothyroidism (SCH) is characterized by an average level of tetraiodothyronine (T4) and triiodothyronine (T3) and an uncharacteristic rise of serum thyroid-stimulating hormone (TSH). The occurrence of hypothyroidism is about 4-5% in the developed world and about 4- 15% worldwide, which is increasing at an alarming rate. Mostly, Subclinical hypothyroidism (SCH) has been considered in two main categories based on the elevation in serum thyroid-stimulating hormone (TSH) level. The first category included a mild increase in TSH levels, i.e., 4.0–10.0 mU/l, while the second category involved a more critically increased TSH value, i.e., &gt;10 mU/l. For overt hypothyroidism, treatment is based on symptoms, while subclinical hypothyroidism didn’t follow the same due to the asymptomatic behaviour of the disease. Additionally, subclinical hypothyroidism is associated with cardiovascular diseases, complications during pregnancy and diabetes, etc. In the current review, we mainly discussed the diagnosis of subclinical hypothyroidism, possible complications, management of SCH with ayurvedic remedies, and some Yogasanas preferred in managing the disease.

Clinical concordance assessment should be an integral component of laboratory method comparison studies: A regression transference of routine clinical data approach

Manufacturer-provided assay-specific reference intervals may not compensate for between assay differences leading to method related clinical discordance. Not all laboratories, however, assess clinical concordance as part of method comparison studies. We assessed the utility of method comparison data combined with routine clinical data to assess method related clinical concordance in the diagnosis and management of subclinical hypothyroidism (SCH).Passing-Bablok method comparison regression analysis was performed for both thyroid stimulating hormone (TSH) and free thyroxine (fT4) from 100 samples analysed by Abbott and Roche methods. Primary care samples indicative of SCH were identified from the laboratory information system (LIMS) of two laboratories (one with Roche methods and one with Abbott) over four months. For Roche and Abbott TSH and fT4 results, the Passing-Bablok regression equations were used to predict Abbott and Roche results respectively. The predicted results were interpreted using manufacturer-provided assay-specific reference intervals and compared to those of the previous SCH sample exchange study.On laboratory method comparison, Roche TSH and fT4 results were 30 ± 13% and 16 ± 7% higher compared to Abbott assays respectively. Of those with results indicative of SCH by Roche assays, 76.8% would have had normal thyroid function using predicted Abbott assay results and 46.9% of those with results indicative of SCH by Abbott assays would have had a biochemical indication for levothyroxine replacement using predicted Roche assay results. The results from the regression-based approach were comparable to the previous SCH sample exchange study.A regression-based approach using routine method comparison data and real-world clinical data identifies potential clinical discordance. We suggest that clinical concordance assessment be an integral component of laboratory method comparison studies.

A systematic review on the prevalence and management of subclinical hypothyroidism in patients with Type 2 Diabetes Mellitus

Background: Subclinical hypothyroidism (SCH) remains one of the most common biochemical manifestations of thyroid dysfunction.1 Similarly, type 2 diabetes mellitus (T2DM) is considered the most common metabolic disorder in clinical practice.2Methods: This is a systematic review to ascertain the prevalence and optimum management approach for thyroid dysfunction in patients with T2DM. We conducted a search on PubMed and Google scholar (Figure 1) for articles published between 2010-2020 using the following keywords: subclinical hypothyroidism, type 2 diabetes mellitus, thyroid diseases, diabetic retinopathy, diabetic nephropathy, and diabetic complications. Results: The prevalence of SCH in T2DM patients ranges from 7.8% to 23 % (average around 13.4%). In comparison, the prevalence of SCH in the general population ranges from 6% to 10%. SCH has a higher prevalence in females, older age &gt;60 years old, long duration of T2DM, positive thyroid autoantibodies, glycated hemoglobin (Hba1c) 8%, and obese patients (risk factors).3 The prevalence of SCH in patients with diabetic retinopathy (DR) ranges from 17.3% to 43.3%. Also, the prevalence of SCH among patients with diabetic nephropathy (DN) ranges from 18.1% to 36%. Screening for thyroid dysfunction in T2DM at diagnosis is recommended and justified (Table 1). If patients with SCH have a risk of cardiovascular disease (CVD), DR, DN, symptomatic, presence of goiter, pregnant women, and continuous sustained increases of thyroid-stimulating hormone (TSH) on follow-up, it is recommended to start low dose levothyroxine which improves morbidity. Conclusion: The prevalence of SCH is relatively high in T2DM patients. This supports routine screening of such patients for thyroid dysfunction especially in patients with risk factors and diabetic complications (DR, DN), and consideration of thyroxine replacement wherever warranted although more evidence from randomized controlled trials is needed to explore the possible causal relationships.

2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Part 1

2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Part 1

Management strategies for patients with subclinical hypothyroidism: a protocol for an umbrella review

BackgroundSubclinical hypothyroidism is a thyroid disorder diagnosed from the laboratory blood test results of otherwise asymptomatic patients. It has been associated with poor cardiovascular outcomes, mortality and progression to overt thyroid hormone deficiency. Current guidelines on the management of subclinical hypothyroidism differ because of conflicting evidence on long-term treatment benefits. Even though there are several existing systematic reviews on its clinical outcomes, no definitive conclusion has been reached yet. As such, a new synthesis could help provide more insight and consensus on this topic. To this purpose, this umbrella review will evaluate and synthesise current evidence on the long-term clinical outcomes of the different management strategies for subclinical hypothyroidism.MethodsThis is a protocol for an umbrella review on the management strategies for subclinical hypothyroidism. We will conduct literature searches in multiple electronic databases (from inception onwards), namely MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, Epistemonikos database, PDQ Evidence and the PROSPERO register. There will be no restriction on the date or language of publication. Additional material will be identified through grey literature searches and citation chaining. Review inclusion criteria will be patients with subclinical hypothyroidism, receiving treatment or monitoring, no restrictions on the comparators used and with cardiovascular events, frailty fractures, quality of life and all-cause mortality as primary outcomes of interest. Two reviewers will independently screen all citations, full-text articles and abstract data on a pre-piloted form in duplicate. Methodological quality (or bias) of included studies will be appraised using AMSTAR-2. Any conflicts that arise will be resolved through discussion or involving a third reviewer. A narrative synthesis will be provided with information presented in the main text and tables to summarise and explain the characteristics and findings of the included reviews. Even so, it is not expected that a meta-analysis will be performed due to review variability. Study limitations and methodological quality assessments will also be reported to provide context for the overall summary of evidence.DiscussionThis review will provide a comprehensive summary of the effects of the pharmacological and non-pharmacological management of subclinical hypothyroidism on specific long-term clinical outcomes. It is anticipated that the findings of this umbrella review will aid in the development of consensus-based clinical recommendations for subclinical hypothyroidism, as well as highlight areas for future research. Review findings will be disseminated primarily through peer-reviewed publications.Systematic review registrationPROSPERO CRD42021235172

Outcomes in Pregnant Patients with Subclinical Hypothyroidism and Thyroid Autoimmunity: A Critical Appraisal of Recent Randomized Controlled Trials

The management of subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) in pregnancy is still uncertain. Over the years, several scientific societies published guidelines on the management of thyroid dysfunction before, during, and after pregnancy, the most recent ones being published by the American Thyroid Association (ATA) in 2017. This study aimed to review the published literature in the field from 2017 onward to investigate whether new findings can change ATA recommendations. A literature search was conducted in PubMed between March 2017 (date of the publication of the ATA guidelines) and March 2020. The research was restricted to randomized controlled trials (RCTs), having pregnancy-related complications in patients with SCH and TAI as the main focus. A total of 5 RCTs were retrieved, 2 of which investigated pregnant women with SCH and 3 with TAI. Selected studies displayed proofs against treating maternal SCH and hypothyroxinemia because no benefit from LT4 was demonstrated in offspring intelligence quotient and in pregnancy outcomes; moreover, they reported proofs against treating TAI patients because no benefit from LT4 was demonstrated in improving pregnancy rate or live birth rate or reducing miscarriage rate.RCTs published from 2017 to 2020 might have a significant impact on current ATA guidelines. In particular, they suggested that isolated hypothyroxinemia and SCH should not be treated and that considering treatment in antibodypositive women, especially those with TSH of 2.5-4.0 mIU/L, would not be justified; they suggested that infertility and miscarriage rates are not decreased by LT4 treatment in euthyroid antibody-positive women seeking pregnancy.

The diagnosis and management of subclinical hypothyroidism is assay-dependent- Implications for clinical practice.

We assessed the commutativity of Roche and Abbott thyroid assays in the diagnosis and management of subclinical hypothyroidism (SCH). The Roche and Abbott thyroid assays are used by approximately 75% of clinical laboratories in the UK. Consecutive samples received from primary care on patients with SCH who had a raised thyroid-stimulating hormone (TSH) <10mIU/L and a normal free thyroxine (fT4) from two laboratories using either Roche or Abbott thyroid assays were identified over 10 working days. Following identification, samples were analysed at the other site within 24hours. Diagnostic and management discordance were studied using the relevant manufacturer-provided reference ranges. We identified 93 patients with SCH (53 using the Roche assay). Roche TSH and fT4 results were respectively 40%±15% and 16%±7% higher (P<.001) compared to Abbott results. Of the 93 patients, 41 (44%) were concordant for SCH on both methods. Of the 53 patients with SCH on the Roche assays, 40 (75.5%) had normal thyroid function and 13 (24.5%) had SCH when analysed using the Abbott assays. Of the 40 patients with SCH on the Abbott assays, 28 (70%) had SCH and 12 (30%) had results indicative for levothyroxine replacement when analysed on the Roche assays. Of these 12 patients, four had TSH>10mIU/L, five had low fT4 and three had both. The diagnosis and management of SCH is strikingly different when using TSH and fT4 assays provided by Abbott Laboratories and Roche Diagnostics. Clinicians and laboratorians should be aware that between-assay differences and variations in reference ranges will directly impact the diagnosis and management of subclinical hypothyroidism.

Multinational Survey of Treatment Practices of Clinicians Managing Subclinical Hypothyroidism in Older People in 2019

Background: International societies have recommended that levothyroxine should not routinely be prescribed in older individuals for the management of mild subclinical hypothyroidism (SCH). However, it is unknown whether clinicians managing people with SCH are either aware of or adhere to these guidelines. Methods: A web-based survey of members of several international thyroid associations and general practitioners in North-East England was conducted. Respondents were presented with a vignette of an 80-year-old gentleman with mild persistent SCH experiencing tiredness. Multivariable logistic regression analyses were performed to evaluate predictors of awareness of guidelines and responses to treatment. Results: The survey response rate was 21.9% (565/2,583). Only 7.6% of clinicians were unaware of guidelines regarding management of SCH in older people. Twenty percent of clinicians stated that they would treat the older patient with mild SCH, whereas 13% were unsure. Clinicians from North America were more likely to treat the older person with mild SCH than clinicians from elsewhere (OR 2.24 [1.25–3.98]). Likewise, non-endocrinologists were also more likely than endocrinologists to treat the older person with mild SCH (OR 3.26 [1.45–6.47]). Conclusion: The majority of clinicians are aware of guidelines regarding management of SCH in older individuals. However, a considerable proportion of clinicians would still treat an older person with non-specific symptoms and mild SCH. These guidelines need to be disseminated more widely and more research is required to understand barriers to adherence to international recommendations.

Biochemical and Ultrasound Characteristics of Subclinical Hypothyroid Patients in North of Jordan: Who Was Treated?

BackgroundEarly diagnosis and management of subclinical hypothyroidism (SCH) are important to avoid the risk of developing overt hypothyroidism. This study aimed to evaluate patients with subclinical hypothyroidism (SCH), in regard to their biochemical characteristics, and ultrasound features, and factors associated with initiating treatment for this condition.MethodsThis was a retrospective study, which reviewed the data of patients who visited the Endocrinology clinic of a tertiary hospital in Jordan, King Abdullah University Hospital. Patients who visited the clinic with SCH over 1 year, Jan 2016–Dec 2016, were included. The charts were reviewed again 2 years later to check patients who started L-thyroxine for the different indications of treatment of SCH. Thyroid function tests (free T3, free T4, and TSH) and thyroid peroxidase antibodies (TPO-Ab) were found to be measured for all cases (n=287), among whom, thyroid ultrasound was done for 43 patients.ResultsMost patients were females (88.1%). Mean age was 42.36 (±15.36 years). Positive TPO-Ab status was associated with higher TSH (p=0.056), lower free T4 levels (p= 0.012), and more patients treated with L- thyroxine for SCH in 2 years (p=0.001). On ultrasound, hypoechogenicity was more predominant among TPO-Ab positive patients than TPO-Ab negative patients (78% vs 30%).ConclusionSCH patients with positive TPO-Abs were more likely to be treated for this condition based on the various indications, and more likely to have had hypoechogenicity on ultrasound. Hence, thyroid ultrasonography and TPO-Ab status should be implemented early in evaluating and treating patients with SCH.

Efficacy of Vyoshadi Guggulu and Shadushana Churna in the management of subclinical hypothyroidism: An open labelled randomized comparative pilot clinical trial.

Background:Subclinical hypothyroidism (SCH) is defined as a mildly reduced function of the thyroid gland having elevated serum thyroid-stimulating hormone (TSH) level and normal concentrations of free tri-iodothyronine (FT3), free tetra-iodothyronine (FT4), T3 and T4. It occurs due to “Agnimandya” (low metabolic activity) at the systemic and cellular level. Vyoshadi Guggulu and Shadushana Churna having its effect on Agni (a root cause of SCH) are expected to prevent overt hypothyroidism and revert subclinical stage to euthyroid.Aim:This study was planned to evaluate and compare the efficacy of Vyoshadi Guggulu and Shadushana Churna in the management of Dhatvagnimandya with special reference to sub-clinical hypothyroidism (SCH).Materials and methods:Patients having serum TSH levels between 5 and 10 mlU/L and normal T3 and T4 values were diagnosed as SCH. A total of 30 patients were registered and randomly divided into two groups. In group A, patients were treated with Vyoshadi Guggulu (6 g), while in group B with Shadushana Churna (3 g) twice a day after lunch and dinner for 60 days. The assessment was done through changes in baseline and after treatment values of serum TSH level. Outcomes of the trial were analyzed using SigmaStat 4.0 version (trial) software. Student's paired t-test was used for within-group assessment, while unpaired t-test was used for intergroup comparison of the normally distributed parametric data.Observations and Results:Ten patients in group A and 11 in group B could complete the course of treatment. The findings revealed that therapy in group A and B showed decrease of 16.61% (P = 0.0494) and 26.29% (P = 0.0140) in serum TSH, respectively, 1.80% (P = 0.025) and 1.36% (P = 0.019) decrease in body mass index (BMI), respectively. The decrease in TSH and BMI was statistically significant in each group. In comparison, the decrease in serum TSH (P = 0.384) and BMI (P = 0.677) was statistically insignificant.Conclusions:Vyoshadi Guggulu and Shadushana Churna are statistically equally effective to reduce serum TSH and BMI in the management of SCH.

Subclinical hypothyroidism in pregnancy.

Subclinical hypothyroidism (SCH) is a common diagnosis among women of reproductive age. The importance of sufficient maternal thyroid supply during pregnancy is well known. Nevertheless, the effects of SCH during pregnancy and the efficacy of its treatment on maternofetal outcomes are not well established. This review discusses the recent evidence on SCH in pregnancy and how this evidence is reflected in current clinical care. Recent observational studies have found a positive association between SCH during pregnancy and adverse maternal, neonatal and offspring outcomes, mainly in thyroid peroxidase autoantibody positive women. Although interventional studies have shown a benefit of levothyroxine (LT4) treatment on selected pregnancy outcomes, there was no effect on offspring neurodevelopment. Current evidence strengthens the association between SCH with both maternofetal and offspring adverse outcomes. An earlier and more individualized diagnostic assessment taking into consideration predictors of thyroid dysfunction and major risk factors for complications could result in better management of SCH during pregnancy. The effectiveness of LT4 on improving maternofetal and long-term offspring outcomes is still not fully elucidated.

Thyroid hormone therapy for subclinical hypothyroidism.

Subclinical Hypothyroidism (SCH) is defined as a raised level of serum TSH level in the presence of normal circulating free thyroid hormones. SCH is a highly prevalent condition displaying some peculiarities, both in terms of the diagnostic and therapeutic approach, when specific population and/or concomitant diseases are taken into account. The debate upon whether LT4 therapy should be initiated or not in patients with SCH is a long lasting one and still it remains controversial. Current evidence supports the concept that the clinical consequences of SCH may be profoundly different in relation to several patient-specific characteristics. Aim of the present review is to provide updated indications for SCH treatment in specific clinical settings. These will include the management of SCH in obese and diabetic patients, in pregnant women, and in specific age groups. Treatment modalities, including LT4 doses and recommended follow-up strategy will also be discussed. In the era of "precision medicine" the decision to-treat-not-to-treat SCH should be individualized taking into account risks and beneficial outcomes of LT4 therapy. With this in mind, we reviewed the most relevant studies in the recent literature in order to provide evidence for or against LT4 replacement therapy for SCH in specific clinical settings.

Subclinical hypothyroidism during pregnancy: the Melbourne public hospitals consensus.

Interest in potential adverse outcomes associated with maternal subclinical hypothyroidism (normal free T4, elevated thyroid-stimulating hormone (TSH)) has increased significantly over recent years. In turn, the frequency of maternal thyroid function testing has risen, despite universal thyroid function screening not being recommended, leading to a marked increase in referrals to obstetric endocrinology clinics. In 2017 the American Thyroid Association revised their diagnostic and management guidelines. Although welcome, these new guidelines contain recommendations that may cause confusion in clinical practice. To ensure uniform practice in the diagnosis and management of subclinical hypothyroidism in pregnancy across all Melbourne public hospitals. Endocrinology and obstetric representatives from all Melbourne public hospital networks reviewed the 2017 American Thyroid Association guidelines and other relevant literature to develop a consensus for diagnosing and treating subclinical hypothyroidism during pregnancy in Melbourne. The consensus guidelines were then referred to the Endocrine Society of Australia for comment and endorsement. Consensus was achieved and the guidelines were endorsed by the Council of the Endocrine Society of Australia. Trimester and assay-specific TSH reference intervals derived from healthy local populations should be used, where available. When unavailable, a TSH cut-off of 4 mU/L (replacing the previously recommended 2.5 mU/L) should be used to initiate treatment, irrespective of thyroid auto-antibody status. The recommended starting dose of levothyroxine is 50 μg daily, with a therapeutic TSH target of 0.1-2.5 mU/L. Levothyroxine should generally be ceased after delivery, with some exceptions. Hospitals will ensure smooth transfer of care back to the woman's general practitioner with clear documentation of pregnancy thyroid management and a recommended plan for follow-up. Fewer women will be classified as having subclinical hypothyroidism during pregnancy, which is likely to lead to reductions in emotional stress, hospital visits, repeated blood tests and financial costs. Uniform clinical practice will occur across Melbourne.